| Hyperprolactinemia Classification and external resources |
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| ICD-10 | E22.1 |
|---|---|
| ICD-9 | 253.1 |
| DiseasesDB | 6314 |
| eMedicine | med/1098 |
| MeSH | D006966 |
Hyperprolactinaemia (BrE) or hyperprolactinemia (AmE) is the presence of abnormally-high levels of prolactin in the blood. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings E00-E35 - Endocrine diseases (E00-E07 Thyroid gland / Thyroid hormone ( Congenital iodine-deficiency syndrome ( The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books British English or UK English ( BrE, BE, en-GB) is the broad term used to distinguish the forms of the English language used in the Phonology North American English regional phonology In many ways compared to English English, North American English is conservative in its Phonology. Prolactin ( PRL) or Luteotropic hormone ( LTH) is a Peptide hormone primarily associated with Lactation. Normal levels are less than 580 mIU/L for women, and less than 450 mIU/L for men. A Reference range is a set of values used by a Health professional to interpret a set of Medical test results
The hormone prolactin is downregulated by dopamine and is upregulated by estrogen. Dopamine is a Hormone and Neurotransmitter occurring in a wide variety of animals including both vertebrates and invertebrates Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, A falsely-high measurement may occur due to the presence of the biologically-inactive macroprolactin in the serum. Macroprolactin is a physiologically inactive form of Prolactin found in a small proportion of people This can show up as high prolactin in some types of tests, but is asymptomatic.
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Causes
Hyperprolactinaemia may be caused by either disinhibition (e. g. , compression of the pituitary stalk or reduced dopamine levels) or excess production from a prolactinoma (a pituitary gland adenoma tumour). A prolactinoma is a Benign Tumor ( Adenoma) of the Pituitary gland that produces a Hormone called Prolactin. An adenoma is a collection of growths (-oma of glandular origin A blood serum prolactin level of 1000–5000 mIU/L could be from either mechanism, but >5000 mIU/L is likely due to the activity of an adenoma with macroadenomas (large tumours over 10 mm diameter) whose levels of prolactin are up to 100,000 mIU/L. Hyperprolactinemia inhibits gonadotropin-releasing hormone (GnRH) by increasing the release of dopamine from the arcuate nucleus of the hypothalamus (dopamine inhibits GnRH secretion), thus inhibiting gonadal steroidogenesis, which is the cause of many of the symptoms described below. Gonadotropin-releasing hormone ( GNRH) also known as Luteinizing-hormone releasing hormone ( LHRH) is a tropic Peptide Hormone Dopamine is a Hormone and Neurotransmitter occurring in a wide variety of animals including both vertebrates and invertebrates The arcuate nucleus (or infundibular nucleus is an aggregation of Neurons in the mediobasal Hypothalamus, adjacent to the Third ventricle and the Median The hypothalamus links the Nervous system to the Endocrine system via the Pituitary gland (hypophysis
There is a suspicion that Minoxidil, a potassium channel opener, may be related to the development of this disease. A two-year test with Minoxidil, under normal dosing parameters, was carried out on rats, which caused pheochromocytomas in both males and females, and preputial gland adenomas in males[1].
Physiological causes
Physiological causes (i. e. , as result of normal body functioning): pregnancy, breastfeeding, stress, sleep. Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female Breastfeeding is the feeding of an Infant or young Child with Breast milk directly from human Breasts, not from a Baby bottle or other
Prescription drugs
Use of prescription drugs is the most common cause of hyperprolactinaemia. Prolactin secretion in the pituitary is normally suppressed by the brain chemical dopamine. Dopamine is a Hormone and Neurotransmitter occurring in a wide variety of animals including both vertebrates and invertebrates Drugs that block the effects of dopamine at the pituitary or deplete dopamine stores in the brain may cause the pituitary to secrete prolactin. These drugs include the major tranquilizers (phenothiazines), trifluoperazine (Stelazine), and haloperidol (Haldol); some antipsychotic medications; metoclopramide (Reglan), used to treat gastroesophageal reflux and the nausea caused by certain cancer drugs; and, less often, alpha-methyldopa and reserpine, used to control hypertension; and oestrogens and TRH. A sedative, or more specifically a sedative-hypnotic, is a substance that depresses the Central nervous system (CNS resulting in calmness relaxation sleepiness Phenothiazine is the Organic compound with the formula S(C6H42NH Trifluoperazine (sold as Eskazinyl, Eskazine, Jatroneural, Modalina, Stelazine, Terfluzine, Trifluoperaz Trifluoperazine (sold as Eskazinyl, Eskazine, Jatroneural, Modalina, Stelazine, Terfluzine, Trifluoperaz Haloperidol is a Typical antipsychotic. It is in the Butyrophenone class of Antipsychotic medications and has pharmacological effects similar Haloperidol is a Typical antipsychotic. It is in the Butyrophenone class of Antipsychotic medications and has pharmacological effects similar Antipsychotics are a group of Psychoactive drugs commonly but not exclusively used to treat Psychosis, which is typified by Schizophrenia. Metoclopramide ( INN) (ˌmɛtəˈkloʊprəmaɪd or /ˌmɛtəˈklɒprəmaɪd is a potent Dopamine receptor antagonist used for its Antiemetic and Prokinetic Metoclopramide ( INN) (ˌmɛtəˈkloʊprəmaɪd or /ˌmɛtəˈklɒprəmaɪd is a potent Dopamine receptor antagonist used for its Antiemetic and Prokinetic Gastroesophageal reflux disease ( American English and Canadian English) or Gastro-oesophageal reflux disease ( British English, Hiberno-English Methyldopa or alpha-methyldopa (brand names Aldomet, Apo-Methyldopa, Dopamet, Novomedopa) is a centrally-acting adrenergic Antihypertensive Reserpine is an Indole Alkaloid Antipsychotic and Antihypertensive drug that has been used for the control of high blood pressure Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, Thyrotropin-releasing hormone ( TRH) also called thyrotropin-releasing factor ( TRF) thyroliberin or protirelin, is a tropic
Diseases
Prolactinoma or other tumors arising in or near the pituitary — such as those that cause acromegaly or Cushing's syndrome — may block the flow of dopamine from the brain to the prolactin-secreting cells, likewise, division of the pituitary stalk or hypothalamic disease. Acromegaly (from Greek akros "extreme" or "extremities" and megalos "large" - extremities enlargement is a Syndrome Also see Infundibulum for other uses of the term The pituitary stalk (also known as the infundibular stalk or simply the infundibulum Other causes include chronic renal failure, hypothyroidism, and sarcoidosis. Chronic kidney disease (CKD also known as chronic renal disease, is a progressive loss of renal function over a period of months or years Hypothyroidism is the disease state in humans and animals caused by insufficient production of Thyroid hormone by the Thyroid gland. Sarcoidosis, also called sarcoid (from the Greek sarx, meaning "flesh" or Besnier-Boeck disease, is an immune system disorder characterized Some women with polycystic ovary syndrome may have mildly-elevated prolactin levels. Polycystic ovary syndrome abbreviated PCOS or PCO (also known clinically as Stein-Leventhal syndrome, Sclerocystic ovary syndrome, Hyperthecosis
Apart from diagnosing hyperprolactinaemia and hypopituitarism, prolactin levels are often determined by physicians in patients that have suffered a seizure, when there is doubt as to whether this was an epileptic seizure or a non-epileptic seizure. Hypopituitarism is the decreased ( hypo) secretion of one or more of the eight Hormones normally produced by the Pituitary gland at the base of the Brain An epileptic seizure is caused by excessive and/or hypersynchronous electrical Neuronal activity and is usually self-limiting Non-epileptic seizures are paroxysmal events that mimic an Epileptic seizure but do not involve abnormal rhythmic discharges of cortical Neurons They are Shortly after epileptic seizures, prolactin levels often rise, whereas they are normal in non-epileptic seizures.
Idiopathic
In many patients, elevated levels remain unexplained and may represent a form of hypothalamic-pituitary dysregulation.
Symptoms
In women, a high blood level of prolactin often causes hypoestrogenism with anovulatory infertility and a decrease in menstruation. Hypoestrogenism refers to a lower than normal level of Estrogen. Female infertility|Male infertility Infertility primarily refers to the biological inability of a Man or a Woman to contribute to conception. See also "Mensuration" a term sometimes used to describe Measurement, particularly in the context of Forestry. In some women, menstruation may disappear altogether (amenorrhea). Amenorrhoea ( BE) amenorrhea ( AmE) or amenorrhœa, is the absence of a Menstrual period in a woman of reproductive age In others, menstruation may become irregular or menstrual flow may change. Women that are not pregnant or nursing may begin producing breast milk. Breast milk refers to the Milk produced by a mother to feed her baby Some women may experience a loss of libido (interest in sex). Libido in its common usage means Sexual desire however more technical definitions such as those found in the work of Carl Jung, are more general referring to libido Intercourse may become painful because of vaginal dryness. Sexual intercourse, in its biological sense is the act in which the male reproductive organ (in humans and other higher animals enters the female reproductive tract
In men, the most common symptoms of hyperprolactinemia are decreased libido, erectile dysfunction, and infertility. Libido in its common usage means Sexual desire however more technical definitions such as those found in the work of Carl Jung, are more general referring to libido Female infertility|Male infertility Infertility primarily refers to the biological inability of a Man or a Woman to contribute to conception. Because men have no reliable indicator such as menstruation to signal a problem, many men with hyperprolactinemia being caused by an adenoma may delay going to the doctor until they have headaches or eye problems caused by the enlarged pituitary pressing against nearby eye nerves. See also "Mensuration" a term sometimes used to describe Measurement, particularly in the context of Forestry. A headache ( cephalalgia in medical terminology is a condition of pain in the Head; sometimes Neck or upper back pain may also be interpreted They may not recognize a gradual loss of sexual function or libido. Libido in its common usage means Sexual desire however more technical definitions such as those found in the work of Carl Jung, are more general referring to libido Only after treatment do some men realize they had a problem with sexual function. In men excess prolactin may also cause Gynecomastia.
Because of hypoestrogenism, hyperprolactinaemia can lead to osteoporosis. Osteoporosis is a Disease of Bone that leads to an increased risk of fracture.
Diagnosis
A doctor will test for prolactin blood levels in women with unexplained milk secretion (galactorrhea) or irregular menses or infertility, and in men with impaired sexual function and, in rare cases, milk secretion. Galactorrhea or galactorrhoea is the spontaneous flow of Milk from the Breast, unassociated with Childbirth or nursing The menstrual cycle is a recurring cycle of physiologic changes that occurs in reproductive-age Females Overt menstruation (where there is blood flow from the Female infertility|Male infertility Infertility primarily refers to the biological inability of a Man or a Woman to contribute to conception. If prolactin is high, a doctor will test thyroid function and ask first about other conditions and medications known to raise prolactin secretion. The thyroid is one of the largest Endocrine glands in the body While a plain X-ray of the bones surrounding the pituitary may reveal the presence of a large macro-adenoma, the small micro-adenoma will not be apparent. X-radiation (composed of X-rays) is a form of Electromagnetic radiation. Magnetic resonance imaging (MRI) is the most sensitive test for detecting pituitary tumors and determining their size. MRI scans may be repeated periodically to assess tumor progression and the effects of therapy. Computed Tomography (CT scan) also gives an image of the pituitary, but it is less sensitive than the MRI. Computed tomography (CT is a Medical imaging method employing Tomography.
In addition to assessing the size of the pituitary tumor, doctors also look for damage to surrounding tissues, and perform tests to assess whether production of other pituitary hormones is normal. Depending on the size of the tumor, the doctor may request an eye exam with measurement of visual fields.
Historical eponyms
The following eponyms were established before prolactin levels could be measured reliably in the clinical setting. On occasion, they are still encountered:
- Ahumada-DelCastillo Syndrome, which refers to the association of galactorrhea and amenorrhea
- Chiari-Frommel Syndrome, which refers to extended postpartum galactorrhea and amenorrhea
- Forbes-Albright Syndrome, which refers to galactorrhea-amenorrhea associated with a pituitary tumor.
References
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